New Strain of Bird Flu Found in Egypt Is Resistant to Antiviral Drug

By DONALD G. McNEIL Jr.

Published: January 18, 2007

CORRECTION APPENDED

A strain of avian flu that is resistant to the antiviral drug oseltamivir has been isolated from two family members in Egypt, the World Health Organization said yesterday.

The development is potentially dangerous because oseltamivir, commonly sold under the name Tamiflu, is the chief weapon against the flu strain, H5N1, which many worry could mutate into a strain that could set off a worldwide pandemic.

The health organization emphasized that it was too early to tell whether the resistant strain had developed independently in the two patients, who were both under treatment with the drug, or whether they had picked it up from birds or from each other. The resistant strain did not spread to anyone else, including a third family member who also had avian flu.

''Given the information we have, we don't see any broad public health implications,'' said Dick Thompson, a spokesman for the organization.

Mr. Thompson was unsure which Egyptian cluster of flu infections the patients were part of. But another source said it was one in Gharbiya Province, roughly 50 miles north of Cairo, in which flu killed three people last month in a 33-member family living in one compound.

Oseltamivir-resistant strains were found in three unrelated patients in Vietnam in 2005 but did not spread.

The development ''is not a big surprise, but it certainly is disheartening,'' said Dr. Anne Moscona, an expert on flu treatment at Weill Cornell Medical College.

The oseltamivir-resistant strain in Egypt was susceptible to zanamir, which is sold as Relenza, and to amantadine, which is from an older, cheaper and easier-to-use class of drugs but is not normally used as a first-line treatment because many avian flu strains are resistant to it.

The development, Dr. Moscona said, suggested that doctors might have to consider switching to a cocktail of drugs as first-line treatment, as is done with AIDS medications and sometimes with antibiotics.

Dr. Andrew T. Pavia, chairman of the pandemic influenza task force of the Infectious Diseases Society of America, said it was theoretically possible that resistant strains of the flu had developed simultaneously in two related patients, especially if they were very sick and had been treated with doses of oseltamivir that were too low.

But if one transmitted it to the other, ''it would be very worrisome,'' he said, because previous resistant strains had been very weak at infecting new victims.

Scientists do not know exactly which mutations or how many of them would make the avian flu virus more dangerous, but they have some clues.

The virus now circulating in birds does not attach easily to cells inside human noses or throats. It reproduces more slowly at human temperatures than at bird temperatures, which are slightly higher. It does not detach easily from cells to infect new ones, and it is usually killed by oseltamivir.

Scientists are keeping an eye on the genes that code for those aspects of the virus -- for example, the shape of the spikes on its outer coating, where it binds to cells.

If an oseltamivir-resistant strain spreads, it will complicate the public health response. Governments have been stockpiling oseltamivir, not zanamir. Zanamir is more expensive and also harder to use and to ship, because it is typically sold not as a pill but as a powder that comes in an inhaler resembling a small hockey puck.

An intravenous form exists but has not been approved for use in some countries, including the United States, Dr. Moscona said.

Correction: January 20, 2007, Saturday
An article on Thursday about a strain of avian flu found in Egypt that is resistant to oseltamivir, the chief weapon against the virus, misspelled the name of another drug that remains effective against it. It is zanamivir (sold as Relenza), not zanamir.